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Evaluation of two different semi-automated homogenization techniques in microbiological diagnosis of periprosthetic
Heime Rieber1, Andre Frontzek2, Stephanie Heinrich3
1MVZ Dr. Stein and Colleagues, Division of Microbiology, Tomphecke 45, D-41169, Mönchengladbach, Germany. hrieber@labor-stein.de.
Background:
In microbiological diagnosis of periprosthetic joint infection (PJI) there is no consensus regarding the most suitable and optimal number of specimens to be cultured or the most effective technique of tissue processing. This comparative study analysed the accuracy of two semi-automated homogenization methods with special focus on the volume and exact origin of each sample.
Methods:
We investigated a total of 722 periprosthetic tissue samples. PJI was defined according to the new scoring system for preoperative and intraoperative criteria. We compared the performance of our routinely used single tissue processing by disposable high-frequency disperser with the bead milling method.
Results:
Eighty patients were included. Among forty classified PJIs, 34 patients yielded positive culture results. In 23 cases (68%) exact concordant results were generated with both techniques. However, in seven cases (20%) processing by the disperser and in four cases (12%) by bead milling provided additional positive samples, but without significant difference since the major definition criteria were met in all cases. The percentage of positive results was influenced by the volume and origin of the tissue samples. Results for small tissue samples tended to be better using the bead milling method. This might lead to improved preoperative arthroscopic diagnosis, as the volume of biopsies is generally limited. Six patients had negative results due to previous antimicrobial therapy. Forty other patients were classified as aseptic failures. Neither procedure resulted in any contamination.
Conclusion:
Both methods enable reliable processing of tissue samples for diagnosis of PJI and are suitable for routine use.
Insights
Both high-frequency disperser and bead milling methods reliably process tissue samples for diagnosing periprosthetic joint infection (PJI). Sample volume and origin impact results, with bead milling showing promise for smaller biopsies in arthroscopic diagnosis.
Area of Science:
- Microbiology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Consensus is lacking on optimal methods for microbiological diagnosis of periprosthetic joint infection (PJI).
- Standardized techniques for tissue processing and sample volume are debated.
- Accurate diagnosis is crucial for effective PJI management.
Purpose of the Study:
- To compare the accuracy of two semi-automated tissue homogenization methods for PJI diagnosis.
- To evaluate the influence of sample volume and origin on diagnostic yield.
- To assess the suitability of these methods for routine clinical use.
Main Methods:
- Comparative analysis of 722 periprosthetic tissue samples from 80 patients.
- Evaluation of a high-frequency disperser versus a bead milling method for tissue processing.
- PJI classification based on a new scoring system for preoperative and intraoperative criteria.
Main Results:
- Both methods yielded reliable results, with 68% concordance.
- Disperser and bead milling provided additional positive results in 20% and 12% of cases, respectively.
- Bead milling showed better performance for smaller tissue samples, potentially improving arthroscopic diagnosis.
Conclusions:
- Both high-frequency disperser and bead milling methods are suitable for reliable PJI diagnosis.
- Tissue sample volume and origin are critical factors influencing diagnostic accuracy.
- Further optimization of tissue processing techniques can enhance preoperative diagnosis.
